Kristen Rosen Gonzalez Form 9 QTR II,·"BE A CH //\ HA//\l tt
O FFIC E O F TH E C ITY C LERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeach!l.gov
Telephone: 305.673.7411
September 30, 2022
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find Quarterly Gift Disclosure State Form
(9), for the quarter ending June 2022, for the following City of Miami Beach Personnel:
• Alex Fernandez - Vice-Mayor
• Steven J. Meiner - Commissioner
• Kristen Rosen Gonzalez - Commissioner
• David L. Richardson - Commissioner
Should you have any questions or require any additional information, please contact me at
305.673. 7 411.
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City Clerk
Attachment
Sent Certified Return Receipt
City Clerk
1700 Convention Center Drive
Miami Beach FL 33139
USPS CERTIFIED MAIL
II 11111111 1111
9214 890194038391419360
FLORIDA COMMISSION ON ETHICS
PO BOX 15709
TALLAHASSEE FLORIDA 32317-5709
Fold Here
Return Reference Number:
Username: Patrick Camm
Code Violation # :
Court Case #:
Property Address : :
Permit ID#:
Custom 5:
Postage: $6.8100
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY:
Rosen Gonzalez, Kri sten Citv of Miami Beach
MAILING ADDRESS: OFFICE OR POSITION HELD:
1700 Convention Center Dr Comm issioner
CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEAR
M iam i B each 33139 M iam i-Dade □M A R C H ?JUN E □S E P T E MBER O DECEM BER 2022
PART A- STATEM ENT OF GIFTS
P le ase list be low each gift , the value of w hich you believe to exceed $100, accepted by you during the calendar quarter for which this statement is
be in g fil e d . Y ou are required to de scrib e the gift and state the m o netary value of the gift, the name and address of the person making the gift, and the
date(s) th e gift w as received . If any of the se fa cts, other than the gift description, are unknown or not applicable, you should so state on the form. As
expla ine d m ore fully in the instructio ns on the reverse side of the fo rm , you are no t req uired to discl o se gift s fr om relatives or certain other gifts. You
are not required to file this statem ent fo r any calendar quart er during w hich you did not receive a report able gift.
D AT E D E S C R IP T IO N M O N E TA R Y N A M E O F P E R S O N A D D R E S S O F P E R S O N
R E C E IV E D O F G IF T VA LU E M A K IN G T H E G IFT M A K IN G T H E G IF T
April 7 2022 Miami City Ballet "Swan $2500 ea x 2 Lisa Pollack 2200 Liberty Ave Miami
Ball" Gala Tickets Bcch, FL 33139
May 6 2022 Carbone Beach Activation +3400x2 a-v food /U ),Uy hosted by Major Food Group 0D .
May 10 2022 Aspen VIP Reception hosted by $150eax2 City of Miami 1700 Convention
Major Food Group Beach Center Dr
May 9 2022 Aspen Institute $500 X 2 City of Miami 1700 Convention
Conference Beach Center Dr
y CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B - RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any re ce ip t fo r a gift liste d ab o ve w a s pro vid e d to you by the pe rso n m a king the gift, yo u are req u ire d to att a ch a cop y of tha t rece ip t to th is
fo rm . Y ou m a y att ac h an exp la n a tio n of an y diff ere n ce s be tw e e n the info rm a tio n disclo se d on this fo rm an d the in fo rm atio n on the receip t.
O CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PARTC-O ATH
I, the pe rso n w ho se na m e ap pea rs at the be gin n ing of this fo rm , do
de p o se on oath or affi rm a tio n and say tha t th e info rm a tio n discl osed
m e nts m a de by m e co nstitutes a true accurate ,
to be rep o rt ed by S ectio n 112 .3 14 8 ,
S T ATE OF FL O RI DA • T
couNT or M]tu-2 AO&
Sworn po(or affi rm e d ) an d sub s cribe d before m e by m ean s of
u}pf~ysi cal pre sen ce or [} online not ariz ation , thi s
3O da y of $'Q t ,202 ml
Hozet ~rt .Ac2
(S ig n
(P rint, T ype , or S tam p m m issio ne d N a m e of N o tary P ublic)
P erso na lly Kn own O R P rod uced Ide ntifi catio n
T yp e of Id e nti fi cation Pr o duced ]
PART D - FILI NG INSTRUCTIONS
T his fo rm , w he n du ly sig ne d and no tarized , m ust be filed w ith the C o m m issio n on E thic s, P.O . Dr a w er 15 709 , Ta lla hasse e , Flo rid a 32 3 17 -57 0 9 ; physi
cal ad dre ss: 32 5 Joh n K no x R o ad , B uildin g E , S uite 200 , Tallaha ssee , Flo rid a 32 3 0 3 . T he fo rm m ust be fil e d no later tha n the la st da y of the cale nda
qu a rt er tha t fo llo w s the cale ndar qu a rt e r fo r w hich th is fo rm is fil ed (F or exam p le , if a gift is received in M a rch, it shou ld be disclo se d by Ju ne 30 .)
(S e e reverse side for inst ructio ns) @?" CE FO R M 9 - EF F . 1/20 16 (R efer to R ul e 34 -7.0 10 (1)(g), F.A.C .)
D ate Received D escription of G ift M onetary Value Nam e of Person Address of Person
M aking G ift M aking Gift
June 4 2022 Miami Beach $325 x2 = $650 City of Miami 1700 Convention
Chamber Annual Beach Center Dr
Gala
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